Techniques in splintage and support during reconstruction of the tibia

The aim of this article is to help clinicians and allied professionals understand problems that may arise with use of external fixators in limb reconstruction and trauma, and in particular describe how preventative strategies can be implemented. The indications for splinting and orthotic use with external fixators can be broadly subdivided into those that facilitate functional loading and those that maintain joint integrity and function. Specific techniques to accompany use of external fixators in fracture management and limb reconstruction are described. In particular, problems concerning knee, ankle and foot support together with leg length issues are covered and proposals for dealing with joint subluxation, forefoot deformity and toe clawing, regenerate deformity after fixator removal and oedema control are discussed. The solutions described and illustrated are intended to assist those who use external fixators but do not have regular therapist input for support in the after-care of their patients.